As the next millennium nears, the medical research enterprise of the United States seems poised to make ever greater contributions to humanity's health and well being—and, hence, to both the national and international interest. However, there is a defect in the structure of the country's medical research edifice, which must be repaired. This defect is the progressive, dangerous decline in the number of physician-scientists. The term “physician-scientist” represents the entire species of MD's who devote all or a majority of their professional effort to seeking new knowledge about health and disease through research. This is meant to be an inclusive designation, covering basic, disease-oriented, patient-oriented, population-oriented, and prevention-oriented investigations.

This decline is not a new problem. Former National Institutes of Health (NIH) director James Wyngaarden first called attention to it 20 years ago in his paper entitled,“The clinical investigator as an endangered species”(1). In 1984 Gordon Gill wrote,“The end of the physician-scientist?”(2). Subsequently, the problem has been called to our attention repeatedly (3), but with an important shift of emphasis away from those doing the science and toward the kind of science being done, namely, patient-oriented investigation (4). Despite all this activity, the problem must be readdressed for a number of reasons. First, the entire species of physician-scientist is at risk—not only those doing patient-oriented research. Think of it as conservation biologists would: we've been so focused recently on the spotted owl (that is, physicians who do patient-oriented research) that we haven't noticed that all owls are at risk (that is, all physician-scientists). Second, endangering physician-scientists endangers everyone concerned with medical research. Third, the actions taken to date cannot solve the problem. Finally, this threat can be averted only by bold, concerted action on the part of all of the participants in the country's medical research enterprise.